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Routine HIV Testing for Inpatients Should Be Expanded, Study Says

April 19, 2006

Routine HIV testing of people who undergo treatment in a hospital should be widened to include patients who are not particularly at risk for the virus, according to a study published in the April issue of Mayo Clinic Proceedings, Reuters Health reports. CDC in 1993 recommended that clinical facilities with above average HIV prevalence offer routing testing, but "essentially no one has followed this suggestion," Jeffrey Greenwald, assistant professor of medicine at Boston Medical Center, said. Greenwald and colleagues determined the proportion of HIV-positive patients whose status without routine testing might not have been detected. Of 243 patients, 81 who tested positive and 81 who tested negative through routine testing were compared with 81 patients who tested positive in the ambulatory care setting. The study finds that the disease in patients who were diagnosed through routine testing was more advanced than it was in patients diagnosed as outpatients. At diagnosis, 64 HIV-positive people diagnosed as inpatients were diagnosed with AIDS compared with 21 HIV-positive people diagnosed as outpatients, the study finds. According to Greenwald, "approximately half of the inpatients infected with HIV might not have been identified had testing been left to clinicians who test patients generally only when the clinical suspicion of HIV is significant" (Reuters Health, 4/17). In a related editorial, Judith Feinberg, a professor at the University of Cincinnati, said the study's findings, as well as changes in federal policy on the broadening of testing, "should spur physicians and other health care professionals to assume responsibility for identifying the quarter million individuals as yet undiagnosed" in the U.S. (Feinberg, Mayo Clinic Proceedings, April 2006).

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